Voice Evaluation Research Articles

Anterior Sensorimotor Subthalamic Nucleus Stimulation Is Associated With Improved Voice Function.

Despite the impact of Parkinson disease (PD) on speech communication, there is no consensus regarding the effect of lead location on voice-related outcomes in subthalamic nucleus (STN) deep brain stimulation (DBS). To determine the relationship of stimulation location to changes in cepstral analyses of voice following STN DBS. Speech pathology evaluations were obtained from 14 PD subjects, before and after STN DBS, including audio-perceptual voice ratings (overall severity, loudness, hoarseness changes), measured indices of dysphonia (cepstral peak prominence and cepstral spectral index of dysphonia), and phonatory aerodynamics. The contact locations used for active stimulation at the time of postoperative voice evaluations were determined and assessed in relation to voice outcomes. Voice outcomes remained relatively unchanged on average. Stimulation locations in the anterior portion of the sensorimotor region of the left STN, however, were associated with improvements in voice severity scores, cepstral spectral index of dysphonia, shortness of breath, and phonatory airflow during connected speech. Posterior locations were associated with worsening of these outcomes. Variation in the medial-lateral or dorsal-ventral position on the left, and in any direction on the right, did not correlate with any voice outcome. Active contact placement within the anterior sensorimotor STN was associated with improved perceptual and acoustic-aerodynamic voice-related outcomes. These findings suggest an STN topography for improving airflow for speech, in turn improving how PD patients' voices sound.

Validation of the Brazilian Portuguese CAPE-V Instrument—Br CAPE-V for Auditory-Perceptual Analysis

The Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) scale is a modern, clinical-scientific approach to voice analysis. It has been translated and culturally adapted to Brazilian Portuguese, but it still lacks validation. To validate the Brazilian Portuguese version of the CAPE-V scale using the previously translated and culturally adapted version. Forty voice samples were selected (30 dysphonic, 10 nondysphonic), and the degree of vocal deviation was evaluated by a committee of three voice specialists. Nine voice specialists judged the 40 voice samples plus 20% repetition (total of 48 samples) using the CAPE-V. To ensure construct validity of the CAPE-V, its analysis was compared to the Grade-Roughness-Breathiness-Asthenia-Strain (GRBAS) scale that was performed 48-72 hours later. Finally, the intra- and inter-rater reliability values were verified and the correlation between the nine judges and the previously defined evaluation was analyzed. The Brazilian CAPE-V presented significant intra (0.860-0.997) and inter-rater reliability values (0.707-0.964) for the overall degree and strong correlation with GRBAS (above 0.828). Deviant voice quality had greater consensus among raters than normal voices. A strong correlation was observed between the analysis of the nine raters and that of the committee. CAPE-V is an important diagnostic instrument that contributes to the standardization of vocal quality evaluation in several languages, including Brazilian Portuguese. Thus, its usefulness is neither related to a single language nor to a single set of raters.

How-to videos on YouTube: the role of the instructor

ABSTRACT How-to videos on YouTube have become a popular source for procedural learning. An important difference to traditional educational videos is that the instructor is often not a professional educator, but an amateur or peer. Building on work on social learning from models, this paper explores how instructor characteristics such as model-observer similarity, instructor credibility (expertise, trustworthiness, attractiveness), and conversational human voice influence choice and evaluation of a how-to video. A survey (n = 401) among active Internet users was conducted. Most respondents had used YouTube and had watched how-to videos on YouTube. Respondents preferred videos with instructors that they perceived as experts and trustworthy, and who talked in a conversational human voice. Instructors of the same gender as the viewer were also preferred, especially by males. The instructor variables explained variance in perceived usefulness and intention to use how-to videos above and beyond the technical and instructional quality of the video. However, only conversational human voice and same gender of the instructor turned out to be significant predictors of perceived usefulness and intention to use.

Examining the voice of Israeli transgender women: Acoustic measures, voice femininity and voice-related quality-of-life

Background Transgender women may experience gender-dysphoria associated with their voice and the way it is perceived. Previous studies have shown that specific acoustic measures are associated with the perception of voice-femininity and with voice-related quality-of-life, yet results are inconsistent. Aims This study aimed to examine the associations between specific voice measures of transgender women, voice-related quality-of-life, and the perception of voice-femininity by listeners and by the speakers themselves. Methods Thirty Hebrew speaking transgender women were recorded. They had also rated their voice-femininity and completed the Hebrew version of the TVQMtF questionnaire. Recordings were analyzed to extract mean fundamental frequency (F0), formant frequencies (F1, F2, F3), and vocal-range (calculated in Hz. and in semitones). Recordings were also rated on a voice-gender 7-point scale, by 20 naïve cisgender listeners. Results Significant correlations were found between both F0 and F1 and listeners’ as well as speakers’ evaluation of voice-femininity. TVQMtF scores were significantly correlated with F0 and with the lower and upper boundaries of the vocal-range. Voice-femininity ratings were strongly correlated with vocal-range, when calculated in Hz, but not when defined in semitones. Listeners’ evaluation and speakers’ self-evaluation of voice-femininity were significantly correlated. However, TVQMtF scores were significantly correlated only with the speakers’ voice-femininity ratings, but not with those of the listeners. Conclusion Higher F0 and F1, which are perceived as more feminine, jointly improved speakers’ satisfaction with their voice. Speakers’ self-evaluation of voice-femininity does not mirror listeners’ judgment, as it is affected by additional factors, related to self-satisfaction and personal experience. Combining listeners’ and speakers’ voice evaluation with acoustic analysis is valuable by providing a more holistic view on how transgender women feel about their voice and how it is perceived by listeners.

Relation Between Dysphonia Severity Index (DSI) and Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V)

This study aims to conduct a relationship survey between subjective voice assessment (the Persian version of consensus auditory perceptual evaluation of voice (called ATSHA)) and the Dysphonia Severity index (DSI). Cross-sectional, methodological study. Our sample included 144 adults; 48 patients with different voice disorders and 96 volunteers without voice disorders, hearing complaints or any auditory-perceptual voice disorders. The vocal tasks included in the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and the DSI were performed and recorded. We used subjective and objective assessments to investigate the correlation between the CAPE-V perceptual-auditory assessment parameters and the DSI. Finally, through using the univariate-linear regression and other statistical analyses, we examined the correlation and prediction value of subjective assessment by the DSI. The result of correlation of the total DSI value and individual items with the CAPE-V parameters demonstrated the strongest correlation between the DSI and breathiness (R=0/563) in the second sentence of the CAPE-V scale, and the weakest correlation between the DSI and overall severity (R=0/202) in the sixth sentence. The results of the univariate linear regression model indicated that the highest predictive power was obtained for the DSI and breathiness (R2=0/427) in the sixth sentence in the dysphonic group, while the lowest predictive power was found for low intensity and strain (R2=0/025) in the connected speech in the control group. This study found a significant relationship between the target objective and subjective voice assessment scales in most parameters. Furthermore, the findings of the current study show that the DSI scale, as an objective tool, can predict some auditory-perceptual parameters.

Voice aspects in sulcus coexisting with benign lesions of the vocal folds.

SUMMARYThe purpose of this study was to measure the clinical profile of patients with sulcus who had concomitant benign lesions such as polyp, oedema, cyst, nodules, or fibrous mass of the vocal fold. We reviewed the medical charts of 38 patients who had a diagnosis of sulcus type 2 or 3 (according to Ford). The patients were classified into two groups. The study group consisted of 16 subjects who had sulcus and associated benign lesion; 22 patients diagnosed with sulcus alone were enrolled in a control group. We analysed psychosocial (Voice Handicap Index-30), auditory-perceptual (GRBAS), acoustic measures and videostroboscopic images. In the study group, the mean VHI-30 scores of all subscales ranged from moderate to severe handicap. The difference between groups was significant on the emotional (p = 0.004) and physical (p = 0.007) subscales. On GRBAS scale, the majority of patients from both groups exhibited mild hoarseness, breathiness, asthenic or strained voice, although roughness was more frequently rated moderate; the differences between groups were not statistically significant. The most abnormally increased values were achieved for amplitude values of acoustic parameters, but significant difference between groups was found in Soft Phonation Index only (p = 0.049). Concerning glottal closure, the most frequent finding was irregular chink in the study group, and spindle glottic chink in controls; we found significant differences between groups (p = 0.004). In both series of patients, the most frequent abnormal findings were moderately diminished amplitude and moderately restricted mucosal wave, with no significant difference between groups. Patients with sulcus and coexisting benign lesions were more handicapped on the emotional and physical subscales of VHI-30. The most characteristic shape of the glottal gap was irregular chink in the study group, and spindle chink in the control group. Acoustic evaluation of voice showed that the most severe disturbances affected amplitude parameters. The clinical characteristics indicated that the presence of sulcus primarily determines the quality of voice, and that additional benign pathologies do not drastically affect further voice deterioration. The coexistence of secondary benign vocal fold lesions aggravates the difficulties in making a preoperative diagnosis of sulcus. It is important to clinically suspect the possibility of coexistent sulcus to plan the correct treatment and obtain better voice outcomes.

The Actor's Voice: Vocal Performance Assessment by Different Professionals

The voice production of actors is complex and can be assessed by different professionals. The objective of this study was to measure actor's global vocal performance (GVP) based on overall voice quality (OVQ) and overall severity (OS), by consensus auditory-perceptual evaluation of voice (CAPE-V), and to investigate the possible correlation between these two analyses in actors without self-reported vocal complaints. A total of 39 actors participated in this study, including 20 men and 19 women. Their ages ranged from 18 to 53 years (mean of 33.3 years), with a mean duration of eight years of professional experience. The referred actors were asked to perform predefined CAPE-V tasks and provide one voice sample in which they read a poem at normal loudness; all tasks were recorded. A professional speech-language therapist evaluated the OS based on CAPE-V vocal tasks; scores up to 35.5 mm represented normal parameters, while those from 35.6 to 50.5 mm represented mild deviation, 50.6 to 90.5 mm indicated moderate deviation, and 90.6 to 100 mm indicated severe deviation. A theater director and another speech-language therapist classified the voice samples using the OVQ scale. The OVQ was measured using a 200-mm visual analogue scale. The calculation of terciles allowed the division into three groups regarding the GVP: lowest score group; intermediate score group; and highest score group. The scores of both analyses were compared by sex and groups. Lastly, a correlation analysis was performed between the two analyses for the total sample. There was a significant difference among the three groups and a mild vocal deviation in the lowest score group. In addition, an inversely proportional correlation was observed between GVP and OS. No sex-related differences were observed in the scores for either analyses. The actors without self-reported voice complaints presented differences on GVP scores and their distribution was independent of sex and length of professional experience. Vocal deviation, although mild, on average was greater in actors who had the lowest scores in GVP, with an inversely proportional correlation between these two parameters.

Investigating Validity and Reliability of the Turkish Version of Transsexual Voice Questionnaire (Male to Female)

The problems faced by trans women with regard to their voice may affect their quality of life. For the evaluation of trans women's voice, tools assessing their self-perception are very important, with the Transsexual Voice Questionnaire (TVQMtF ) being one of the most frequently used. The purpose of this study was to investigate the validity and reliability of the Turkish version of the TVQMtF (TVQMtF -TR), which was previously translated into 12 languages. Cross-sectional study. A total of 41 trans women participated in this study. The participants filled out the TVQMtF -TR, the self-perceptions of voice femininity questionnaire, and the World Health Organization Quality of Life Questionnaire-Short Form (WHOQOL-BREF-TR). Additionally, 58.5% of the participants filled out the TVQMtF -TR again two weeks after the first interview. The total Cronbach's-α value of the TVQMtF -TR was 0.972, and the item-total correlation values were found to be between 0.323 and 0.876. The intraclass correlation coefficient value was 0.931. There was a strong negative correlation between TVQMtF -TR and self-perceptions of voice femininity. There was a significant negative correlation between TVQMtF -TR and the psychological and environmental domains of WHOQOL-BREF-TR. However, there was no significant relationship found between the social and physical domains. According to the results of the study, the Turkish version of TVQMtF -TR was considered a valid and reliable tool.

Speech Pathology Utilization and Stroboscopy Before and After Adult Medialization Laryngoplasty

Evaluation of trends and utilization of speech-language-pathology (SLP) services, including stroboscopy, before and after medialization laryngoplasty (ML) over 11 years. Retrospective national US database study conducted using OptumLabs Data Warehouse. Study cohort included patients (age ≥18 years) who underwent ML between January 2007 and December 2016. Primary outcomes were rates of SLP visits in the 12 months before and 12 months after ML. Linear regression analysis was performed assessing for trends utilization across years. Secondary outcomes were predictors of utilization After-ML using multivariable logistic regression. 1114 patients met criteria. Services, including stroboscopy, were utilized by 774 (69%) Before-ML and 697 (63%) After-ML. SLP services, excluding stroboscopy, were utilized by 512 (46%) Before-ML and 478 (43%) After-ML. Vocal cord paralysis was the most common diagnosis, 945 (84.8%) patients. Other service billed were stroboscopy, [Before-ML 676 (60.7%); After-ML 567 (50.9%)], voice evaluation [Before-ML 431(38.7%); After-ML 366 (32.9%)], voice therapy [Before-ML 309 (27.7%); After-ML 339 (30.4%)], laryngeal function studies, [Before-ML 175 (15.7%); After-ML 164 (14.7%)], swallow evaluations [Before-ML 150 (13.5%); After-ML 90 (8.1%)], and swallow therapy [Before-ML 53 (4.8%); After-ML 47 (4.2%)]. SLP utilization Before-ML predicted SLP utilization After-ML [Odds Ratio (95% Confidence Interval): 9.31 (6.78, 12.77)]. Nearly half (49%) of visits occurred in the 6 months around ML. Of those who had voice therapy, the majority (73.7%) had a total of 1 to 5 sessions. Based on this retrospective US national database study, SLP services and stroboscopy are a complementary component of assessment and treatment of patients who undergo ML with the majority of services occurring in the 3 months before and after ML. Future work would benefit from outcome data.

Cepstral Peak Prominence Values for Clinical Voice Evaluation.

PurposeThe goal of this study was to employ frequently used analysis methods and tasks to identify values for cepstral peak prominence (CPP) that can aid clinical voice evaluation. Experiment 1 identified CPP values to distinguish speakers with and without voice disorders. Experiment 2 was an initial attempt to estimate auditory-perceptual ratings of overall dysphonia severity using CPP values.MethodCPP was computed using the Analysis of Dysphonia in Speech and Voice (ADSV) program and Praat. Experiment 1 included recordings from 295 patients with medically diagnosed voice disorders and 50 vocally healthy control speakers. Speakers produced sustained /a/ vowels and the English language Rainbow Passage. CPP cutoff values that best distinguished patient and control speakers were identified. Experiment 2 analyzed recordings from 32 English speakers with varying dysphonia severity and provided preliminary validation of the Experiment 1 cutoffs. Speakers sustained the /a/ vowel and read four sentences from the Consensus Auditory-Perceptual Evaluation of Voice protocol. Trained listeners provided auditory-perceptual ratings of overall dysphonia for the recordings, which were estimated using CPP values in a linear regression model whose performance was evaluated using the coefficient of determination (r 2).ResultsExperiment 1 identified CPP cutoff values of 11.46 dB (ADSV) and 14.45 dB (Praat) for the sustained /a/ vowels and 6.11 dB (ADSV) and 9.33 dB (Praat) for the Rainbow Passage. CPP values below those thresholds indicated the presence of a voice disorder with up to 94.5% accuracy. In Experiment 2, CPP values estimated ratings of overall dysphonia with r 2 values up to .74.ConclusionsThe CPP cutoff values identified in Experiment 1 provide normative reference points for clinical voice evaluation based on sustained /a/ vowels and the Rainbow Passage. Experiment 2 provides an initial predictive framework that can be used to relate CPP values to the auditory perception of overall dysphonia severity based on sustained /a/ vowels and Consensus Auditory-Perceptual Evaluation of Voice sentences.

Posture and dysphonia associations in patients undergoing total thyroidectomy: stabilometric analysis.

The aim of this study is the analysis of postural changes of patients affected by vocal disorders post-thyroidectomy, in the absence of post-operative organ damage, through a stabilometry analysis, evaluating the effectiveness of a speech-language intensive treatment in phoniatric and postural quality recovery. 260 patients with vocal dysfunction after surgery without iatrogenic damage were enrolled. 130 patients were subject to post-surgical logopedic rehabilitative training (Group A); other 130 patients were not subject to any post-surgical treatment (Group B). For all patients, vocal and stabilometric parameters were evaluated before and after 2days and 1month from surgery. Vocal parameters evaluated were Voice Handicap Index-10, Maximum Phonation Time and objective evaluation of voice with Multidimensional Voice Program (MDVP). Stabilometric parameters evaluated were Sway area (mm2) and Sway velocity (mm/s) in firm surface and foam pad with eyes opened and closed. Regarding the stabilometric parameters, Group A obtained a statistically significant recovery of the correct posture statistically significant compared to Group B, after a month of speech therapy. Vocal parameters (VHI, MPT, MDVP) were statistically different between the two groups (p < 0.05), with a better improvement in Group A. Thanks to our study, we have shown that a logopedic rehabilitation therapy in patients with dysfunctional post-thyroidectomy dysphonia improves both the vocal and postural outcomes.

Voice-related complaints and vocal and nonvocal habits of Hindustani classical singers: a questionnaire-based study

Objective This study aimed to profile voice-related complaints, as well as vocal and nonvocal habits among Hindustani classical singers. Method Cross-sectional study design was used to profile voice-related complaints and vocal and nonvocal habits among Hindustani classical singers. Phase I involved developing a questionnaire for exploring vocal and nonvocal habits. Phase II involved the administration of the survey to 61 Hindustani classical singers. Results Based on the overall findings, 41% of singers reported of at least three vocal symptoms. The most common vocal symptoms included out of breath while singing, felling tired after singing and experiencing tension or tightness in neck/shoulder. The commonly reported vocal habits included excessive phone use, loud coughing/sneezing, throat clearing and excessive speaking. A high consumption of caffeinated beverages and spicy food were also reported. Conclusion This study helps to highlight the voice-related complaints and vocal and nonvocal habits of Hindustani classical singers. Further studies, need to explore the prevalence of voice problems incorporating other dimensions of voice evaluation such as acoustic, auditory perceptual, self-reported and laryngeal examination.

Application of High Speed Digital Imaging (HSDI) technique and voice acoustic analysis in the diagnosis of the clinical form of Presbyphonia in women.

&lt;b&gt;Introduction:&lt;/b&gt; The aging process of voice begins after the age of 60 and has an individually variable course. Voice quality disorders at this age are called senile voice (Presbyphonia or Vox Senium). Voice pathology is particularly severe in women. The aim of the study was to diagnose the clinical form of Presbyphonia in elderly women using High Speed Digital Imaging (HSDI) and acoustic voice analysis. &lt;br&gt;&lt;b&gt;Material and methods:&lt;/b&gt; Study included 50 elderly women (average age 69) with dysphonia (Group I). Control group (Group II) included 30 women (average age 71) without voice quality disorders. Visualization assessment has been conducted with High Speed Digital Imaging (HSDI) with High Speed camera (HS). Acoustic evaluation of voice included analysis isolated vowel "a" and continuous linguistic text with Diagnoscope Specialista software. Maximum Phonation Time (MPT) has been determined. &lt;br&gt;&lt;b&gt;Results:&lt;/b&gt; In Group I, 78% of women revealed vocal folds vibrations asymmetry, vibration amplitude increase, Mucousal Wave (MW) limitation and Type D glottal insufficiency (GTs). Acoustic voice analysis proved decrease in F0, increase in Jitter, Shimmer, NHR. In 22% of women, next to vibrations asymmetry, vibration amplitude reduction and MW limitation, Type E glottal insufficiency (GTs) have been found. Acoustic voice analysis revealed slight decrease in F0 and the presence of numerous non-harmonic components in the glottis region. &lt;br&gt;&lt;b&gt;Conclusions:&lt;/b&gt; Vocal folds visualization with HSDI showed edema, less often atrophy in elderly women. Both forms of dysphonia were caused abnormal values of F0, Jitter, Shimmer, NHR in the acoustic voice evaluation and significant reduction of MPT.

Botulinum Toxin injection in Bilateral Vocal Fold Immobility

Introduction: Bilateral vocal fold paralysis (BVFP) is a complicated life-threatening clinical problem. Airway enlargement procedures for bilateral vocal fold immobility, such as cordotomy and arytenoidectomy, permanently impair voice and increase the risk of aspiration. An innovative strategy for restoring ventilation without affecting voice or swallowing is botulinum toxin injection into the thyroarytenoid muscle. Objective: To investigate the effectiveness of thyroarytenoid muscle chemical denervation with botulinum toxin injection in diminishing dyspnea in BVFP by changing the positioning of the paralyzed VFs. Patients and Methods: 12 patients suffering from bilateral vocal folds immobility were enrolled in the study. Botulinum toxin injection was performed into each vocal fold via a per-oral approach. Voice evaluation, laryngoscopic examination, and pulmonary function tests were carried out before and 15 days after the injection. Results: All patients reported improvement of their respiratory symptoms as well as improvement of the pulmonary function studies following the injection. Patients who received repeated injections demonstrated a longer duration of symptoms improvement. Voice handicap index scores were not significantly changed after botulinum toxin injection into each vocal fold. Conclusion: Botulinum toxin injection is a less invasive, short term treatment option improving ventilation in patients with BFVP with little or no effect on voice or swallowing.

Processamento auditivo central em crianças com disfonia: avaliação comportamental e eletrofisiológica

Introdução: O transtorno do processamento auditivo central pode ocorrer em concomitância com outras alterações, assim como a disfonia. Objetivo: Analisar os resultados obtidos na avaliação do processamento auditivo central em crianças com disfonia. Método: Estudo comparativo e de coorte transversal, constituído por 16 crianças de oito a 11 anos reunidas em dois grupos: o Grupo Estudo composto por sete crianças com disfonia funcional ou organofuncional, e o Grupo Controle por nove crianças sem queixas e alterações vocais. Foram realizados os seguintes procedimentos: anamnese, gravação vocal, avaliação perceptivo-auditiva da voz, laringoscopia, avaliação audiológica básica, avaliação do processamento auditivo por meio de testes comportamentais e eletrofisiológicos. Resultados: Houve diferença estatisticamente significativa entre os grupos para as etapas de atenção direcionada no teste Dicótico não verbal, etapa de humming no Padrão de frequência, limiar de detecção de gap e porcentagem de acertos no Gaps in Noise e para a latência do P300. Conclusão: A partir da análise dos resultados verificou-se que o grupo com disfonia apresentou transtorno do processamento auditivo central com alteração nas habilidades auditivas de figura-fundo para sons não verbais, ordenação e resolução temporal e latência do P300 prolongada, sugerindo também um déficit no processamento cognitivo da informação acústica.

Selective vagus-recurrent laryngeal nerve anastomosis in thyroidectomy with cancer invasion or iatrogenic transection.

Immediate recurrent laryngeal nerve (RLN) reconstruction at the time of thyroid cancer extirpation can provide excellent postoperative phonatory function. This study is to present our experience with the methods of RLN reconstruction, and to evaluate the role of selective vagus to RLN anastomosis (SVR) in thyroidectomy. Respective review of RLN reconstruction in thyroid surgery from January 2004 to October 2018 was conducted in two tertiary referral academic medical centers. Immediate RLN reconstruction was performed for primary thyroidectomy patients with intraoperative nerve tumor invasion or iatrogenic transection. Laryngofiberoscopic examination, voice evaluation of maximum phonation time, and GRBAS scale were performed preoperatively, on the second day after surgery, and monthly postoperatively for the first year. A total of 37 patients were enrolled. Twenty-nine RLNs were resected caused by tumor-associated trauma; the other nerves were inadvertently transected. Direct anastomosis (DA) was performed in eight patients, free nerve graft (FNG) was performed in four patients, ansa cervicalis to RLN anastomosis (ARA) was performed in eight patients, and SVR was performed in 17 patients. The mean periods from the reinnervation surgery of DA, SVR, ARA, and FNG to the phonation recovery were 46 ± 19 (days), 41 ± 29 (days), 83 ± 21 (days), and 137 ± 32 (days), respectively. There were improvements in the GRBAS scale of perceptual voice quality at 1 month for DA and SVR, 2months for ARA. Intraoperative SVR reinnervation demonstrated voice improvement postoperatively and might be an effective treatment for thyroidectomy-related permanent unilateral vocal cord paralysis.

Factors Associated with Failure of Botulinum Toxin Injection in Adductor Spasmodic Dysphonia.

Electromyography (EMG) Guided botulinum toxin (BTX) injection is considered first-line treatment for adductor spasmodic dysphonia (SD). Failure rate can range between 6% and 29%. Study objective was to determine which factors were associated with failure. This was a retrospective review conducted at a tertiary, academic center. Adductor SD patients presenting for BTX injections from August 2017 to October 2018 were eligible. Age, gender, Voice Handicap Index (VHI-10), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), number of injections, disease duration, unilateral/bilateral injection, right/left injection, dose quantity, body mass index (BMI), professional voice user, employment, psychiatric comorbidity, breathiness, and dysphagia were investigated. Outcomes included failure as defined by the patient and dosage change. Univariate and multivariate statistical analysis was conducted. Sixty seven out of 564 injections (12%) were categorized as failure by 131 patients. In multivariate analysis, dosage change was associated with shorter duration of good effect (P < .001), BTX dose (P = .016), breathiness (P < .001), bilateral injection (P = .024), dysphagia (P = .012) and professional voice user (P = .021). Failure was associated with first injection with a new physician (P < .001), professional voice user P < .001) and lack of breathiness (P = .003). Failure rate was not associated with age, gender, VHI-10, CAPE-V, disease duration, left/right injection, dose quantity, BMI, psychiatric comorbidity, and dysphagia. Failure rate was 12% and associated with patients' first injection with a physician, professional voice user, and lack of breathiness. Dosage change occurred in 29% of injections and was associated with injection side effects, bilateral injections, BTX dose, professional voice user, and shorter duration of good effect.Level of evidence: 3.

Effect of Muscle Tension Dysphonia on Self-perceived Voice Handicap and Multiparametric Measurement and Their Relation in Female Teachers

Muscle tension dysphonia (MTD) is a common voice disorder in teachers in which subjective and objective dimensions of quality of voice can be impaired. The study aimed to compare voice handicap index (VHI) and dysphonia severity index (DSI) in teachers with and without MTD as well as study correlation between them. Cross-sectional survey. Fifty female teachers were enrolled in the study in two different groups (1) twenty-five teachers with MTD (with mean age of 42.62 ± 3.58 years) and (2) 25 teachers without MTD (with mean age of 44.50 ± 3.49 years). All participants completed the Persian version of VHI and underwent multiparametric measurement of voice by the DSI; these subjective and objective voice measures were compared between two groups and their relation was studied. There was significant difference in the VHI, DSI, and their components in teachers with and without MTD (P < 0.05). No significant correlation was found between the total score of VHI and DSI score in the teachers with MTD (rPearson: 0.04, p: 0.82), although there was significant correlation between them in the teachers without MTD (rPearson: -0.75, p: 0.001). Teachers with MTD demonstrated higher voice handicap and lower voice quality compared to the teachers without MTD. Moreover, dysphonia interrupted relation between the results of self-perceived evaluation and multiparametric measurement of voice in the teachers with MTD in while these assessments were parallel in the healthy teachers. Further studies are recommended to transparent relation between objective and subjective voice assessments in healthy population.

Outcomes of voice therapy in children with benign vocal fold lesions

ObjectiveThis study aims to examine the effect of voice therapy on dysphonia on children with benign vocal fold lesions, as measured by perceptual evaluation using the Consensus Auditory Perceptual Evaluation of Voice (CAPE-V) and acoustic and aerodynamic measures (jitter, shimmer, noise-to-harmonic ratio, phonation threshold pressure, mean airflow during voicing, subglottic pressure during comfortable phonation). Study designProspective disease-specific outcomes database. MethodsSubjects identified in the database consisted of 28 children (14 male, 14 female) between the ages of three and eighteen. Pre- and post-therapy perceptual, acoustic and aerodynamic measures were compared using two-sided paired t-test. ResultsThere was a statistically significant difference in perceptual ratings of voice quality (p < .001) and in phonation threshold pressure before and after therapy (p = .034). While acoustic measures improved after therapy, changes were not statistically significant. ConclusionsChildren with dysphonia secondary to benign vocal fold lesions showed positive change in perceptual ratings of voice quality and in phonation threshold pressure after voice therapy.

Investigating the effects of subthalamic Nucleus–Deep brain stimulation on the voice quality

Introduction: Deep brain stimulation (DBS) is a standard surgical treatment method which is generally applied to subthalamic nucleus in Parkinson’s patients in cases where medical treatment is insufficient in treating the motor symptoms. It is known that Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) treats many motor symptoms. However, the results of studies on speech and voice vary. The aim of the study is analysing the effect of STN-DBS on the characteristics of voice.Materials/methods: A total of 12 patients, (8 male–4 female) with an age average of 58.8 ± 9.6, who have been applied DBS surgery on STN included in the study. The voice recordings of the patients have been done prior to surgery and 6 months after the surgery. The evaluation of voice has been carried out through the instrumental method. The patients’ voice recordings of the /a,e,i/ vowels have been done. The obtained recordings were evaluated by the Praat programme and the effects on jhitter, shimmer, fundamental frequency (F0) and noise harmonic rate (NHR) were analysed.Results: Numerical values of F0 of all female participants have been decreased for all of the vowels postoperatively. In the females; jhitter and fraction parameters were found to be significantly different (0.056 and 0.017, perspectively) for the vowel /e/. In addition, p values in the shimmer for vowels /e,i/ were thought to be clinically significant (.087, .079 and .076) respectively. All these changes in second measurements were found to indicate worsening vocal quality after the DBS in females. In males, there is not any significant difference observed between two measures in any of the parameters of any vowels.Conclusions: Acoustic voice quality deteriorated after STN-DBS predominantly for females however this deterioration was not prominent audio-perceptually. This finding commented as a result of the fact that that voice quality deviance of the participants was not severe.